Mental Health Month “Friends without benefits”

Friendship.

Watching TV shows, reading books, the influence of an ideal, ‘friends forever’ the friends who are there when you need them, friends for life, friends through thick and thin.

Probably should preface this with “unless you are mentally ill”

Why?

Mentally ill people struggle to maintain life-long friendships and connections. An unkind soul may say “can you blame anyone for not being able to put up with THAT?”

Yes.

One reason mentally ill people struggle is the sense of isolation, loss, abandonment, and judgement, all discussed before. Friendship and ties to the community is the basis for survival for most people. Isolation and rejection can lead to suicide and worsening illness. It is not the duty of anyone to befriend a mentally ill person but equally as a society if we put our rapid judgement aside and turned from only seeking ‘fun happy people’ to socialize with, and gave a little thought to those suffering, our empathy would go a long way.

We are selfish on the whole when it comes to friendships. We don’t want to ‘bother’ too much, we don’t want to make an effort. We want something easy and fun. If it’s not we’re likely to drop it.

But the effort we put into our children, our families, our marriages, should equally be considered when looking at friends in need. If we cannot be a good friend are we even a friend? Or are we just a fair-weather friend?

Many people I have spoken with have talked about how much it hurt to be ‘friend dumped’ and how often this occurs when they are going through a hard time. The worst being, it can compound the already existing feelings of worthlessness and self-blame.

It is not the responsibility of others to take care of mentally ill people but it begs the question … if you are only friends with someone when the going is good, are you really friends? If you only want to be friends with someone without any strings attached and no difficult times, how invested are you? In short, are you even a friend?

Friendship is perhaps an art that is lost on us these days, with our increasingly ‘busy’ lives and selfish preoccupations. But remember, society functions well when all of us care about those in our society. If we simply live for ourselves and give no regard to others and their well-being, are we really the good and giving people we envision ourselves to be?

If we are Christian is this the Christian way? If we are Buddhist is this the way of the Buddha? If we are aiming for empathy and treating others as we would hope we would be treated, are we acting accordingly? What would happen if we suffered from a mental illness? What would we expect?

It is worthwhile considering this. A close friend of mine became incredibly ill with a brain tumor and she observed that she lost many friends, including those who went to her church. It showed her the time observed adage that you know who your friends are in your moments of crisis and need. This is where physical and mental health share something in common, in both instances, people flee the individual like rats from a sinking ship.

Finally we can say this is something both mentally ill and physically ill people experience. But why?

People are afraid of illness. They see someone with a brain tumor and act like it’s contagious. They know it’s not logically but this is an instinctive fear. They want to avoid sadness at any cost, they want to avoid reality at any cost, nobody wants to dwell on the possibility of death. It takes a very strong soul to want to go there.

Consequently at your time of need, the very hour you really need people there, you are deserted. Before I began visiting the hospital regularly I was completely unaware of this, I had no idea how many hospital rooms were emptied of visitors and support systems, how many go without any friends to comfort them in their hour of need.

I recall as a kid going to see a friend who was diagnosed with schizophrenia in the state hospital and how he talked about losing all of his friends. It seems like not much has changed.

And ask yourself this … how much would it take to care?

Recently another acquaintance developed Terminal Stage 4 Ovarian Cancer, when asked, her colleagues, who had worked with her for TWENTY YEARS put off going to visit, until someone posted on Facebook ‘she’s going to die! Go see her before she does!’ and then, the herd mentality took over and everyone went to visit. It was ingenuous and false, and I came to see, these people who had worked with this woman for two decades, really didn’t care, they wanted it over with.

I understand the knee jerk response to death and all things unpleasant, but we’re all going to die, is this how we would wish others to react to us? Empathy means, consideration of how we treat others, as much as how others treat us, and the two are connected by an understanding that it cannot be a one way street. As painful as it may be, supporting those in their hour of need is what makes the world a better place. If we are too busy to attend to that, what does it say about our priorities?

The same applies to the mentally ill. This can literally be a life saver, a life line, a much-needed support network. Suicide often occurs because of isolation and a feeling that the world would be a better place if I were not in it. Surely losing friends and being ignored, adds to that feeling and thus, the reverse is true if loyalty and constancy exist.

Obviously some friendships have an expiry date and that’s okay, that’s the nature of the beast, but if you’ve stopped calling someone because you are fed-up with their mental illness and it’s not ‘fun anymore’ consider this, what would you want if you were going through the same thing? Should friendship simply be about benefits?

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Mental Health Month “The Workplace”

Ask many people with mental illness, how’s the workplace? Many will describe the frustrations of trying to work alongside people who either do not know or do not understand the struggles they are going through, the high rates of unemployment, underemployment and patchy employment relating to mental health.

We hear how many working days are lost to mental health, we know this, but as a society we do nothing to improve the resources for those experiencing mental health challenges. Again, for those who have not experienced any mental health issues, they may wonder, what could be so bad as to take people out of the work place?

Where to start? Panic attacks can make going to work feel like a torture. Anxiety can cause reduced career opportunities because of fear, phobias including agrophobia may make it hard to actually venture beyond the house to a place of work, depression may keep a sufferer in bed on days when they are most needed at the office, bipolar can cause a worker to shift from highly productive to shut down over night. Without a full understanding of the complexities of mental disease, your boss is likely as not, ill equipped to handle these things and that is why so many people with mental illness struggle in the work place.

But what are we doing about it?

In recent years, bullying in the workplace has been a topic of discussion and highlights that we have not progressed as far from the playground as we may think. Typically people with mental illnesses are far more likely to be the object of bullying both in the school yard and work place. We hear about work place violence and assume some ‘crazy person’ came and gunned down some innocents, and whilst there is no justification for work place violence, is there any excuse for work place bullying?

It is worth considering this if you work with someone who is being bullied. Stand up for them, let someone know it’s happening, don’t let those tensions get out of hand, and then wonder what you could have done about it after it’s too late and that person commits suicide or brings a gun to work. Equally, if someone is mentally ill and they’re making it hard in the work place let your boss know, so that they (whose job it is) can do their best to resolve the issue.

Let’s look at an example;

One

Jemima is a closeted lesbian who suffers from anxiety. Her work colleague grows suspicious of her ‘life style’ and watches her type in her password, when Jemima is out at lunch, her work colleague ‘hacks’ her email account bringing up private emails of Jemima’s to her girlfriend. The work colleague prints them out and everyone in the office giggles over their content, unbeknown to Jemima. One person in the office feels this is wrong but doesn’t know what to do. What should they do?

This is a true story. The outcome was, nobody did anything, and Jemima ended up leaving her job, feeling that she had no choice after she found out what had happened and experienced severe anxiety and feelings of shame and bullying. Some would blame her for being in the closet, whilst others would understand, sometimes it has to be that way. But what could have changed to prevent this? If one person had stood up and told Jemima’s boss, then thanks to legal changes protecting people’s private-lives, her boss, whether approving of Jemima’s ‘life style’ or not, would be legally bound to act. If they did not act then this could be protested. Additionally, Jemima’s colleague who objected to this hacking, could have told Jemima and urged her to go to HR and report this as a violation. By doing nothing, nothing gets better.

Sometimes when you stand up. You make a difference. It really can take one person to do it, think of Rosa Parks.

Case Two

Jose is Bipolar but feels if he tells anyone at work he will be fired because that’s happened in two previous jobs so he says nothing. When he gets insurance through his job he does not go to see a psychiatrist because he fears his disease being part of his permanent record and worries this will stigmatize him in the future. Consequently he pays for private care and spends a lot of money on medication.

One week he does not have any medication left and doesn’t have the money to replace them. He begins to get the side-effects of not being on his medication including being unable to sleep at night, paranoid thoughts, inability to concentrate and feelings of mania. He is not able to tell anyone what is going on, tries to do his work at home but because of not being well doesn’t do a complete job.

When he returns to work after getting paid and getting more medication his boss tells him he has to let him go because of poor performance. Jose loses his job and now does not have the money for his medication or any health insurance.

What could have been different here?

The American laws concerning healthcare protect us somewhat from workplace discrimination. This is not inclusive and it’s fallible because people can and do make up other reasons for firing their employees. If in doubt speak to the workplace commission in your state about what your rights are, knowing your rights is half the battle. Likewise, Jose’s boss would be breaking the law if he chose to disclose Jose’s health status to anyone else at his work place, so in this sense, choosing to speak to his boss about what was going on, protects Jose more than staying quiet.

The reality is however, that until stigma around mental health is gone, there are always ways to subvert someone based upon prejudice. If your boss is predisposed to thinking ‘everyone with bipolar is a nut-job’ they may circumvent the law and find a way to get rid of you despite your best efforts. Having anyone else on your side improves your chances, as well as letting the proper legal channels know. Ultimately however, not enough is done to self-guard those with mental illness in the work place and this is one failing that needs serious remedy. After all, we need an income to afford health care one way or another, if we cannot get a job, how are we expected to get treated?

The reality of mental illness is many people are in the closet about it, for a plethora of reasons, and until we reduce the stigma and judgement as a society, they have no incentive to come out. Mental illness does not mean you cannot be an asset to any job, but a level playing field means a fair one, where there is no condemnation or presupposition based upon a mental illness diagnosis.

For a GREAT example of mental illness at work – watch the TV series HOMELAND with Claire Danes. It’s one of the most realistic (as far as anything on TV goes) portrayals of the struggle against the system by a young woman with Bipolar 1.

 

Mental Health Month “Shame”

SHAME

“Shame on anyone who provokes unnecessary shame.”

For those who have never experienced mental health issues, it may be possible to consider a mentally ill person as wallowing lazily in their feelings of elected sadness. This may provoke a feeling of ‘isn’t it a shame?’ a sense that they are wasting their life choosing to act and behave this way.

Many times the mentally ill person will be quizzed;

Do you work out?

Do you eat right?

Do you sleep enough?

Sometimes those quizzes are not kind queries but have the double-headed effect of sounding like criticisms. The implication being; If you worked out (better or more often) if you ate better (your fault) if you slept well (rather than badly, by choice) you’d not be sick.

I go back to my earlier point, barring cigarette smokers, would we say this to someone who told us they suffered from cancer? (And is it even morally right to condemn a cigarette smoker for his/her part in their disease?).

Who the hell do we think we are?

Well … we think we are the well ones, the ones who have the answers to the malady of elected depression and/or mental-illness. We think this because we have no ability to empathize with a different way of feeling, because we have no experience of it ourselves or we do and we ‘got over it’ so we assume everyone else can.

It’s worth noting, there are differing types of mental illness (no shit Sherlock!) and of those, differing degrees and/or cause/effects. By this I mean the following;

If you are raped, you may suffer depression, anxiety, flash-backs and PTSD afterward. If you don’t that doesn’t make you stronger. If you do that doesn’t make you weaker. Those symptoms may go in a short time, they may persist, they may last ages. It will depend upon a myriad of factors, mainly, whether you had a pre-existing mental illness or not.

If you are already anxious and depressed and you are raped, then it stands to reason, it will exacerbate pre-existing symptoms. If you are not anxious and depressed and you are raped, you may have fewer symptoms because you are not adding to an existing list of symptoms. Again, taht doesn’t reflect how strong you are.

See it this way … if you have an auto immune disease like thyroid, you are at higher risk of getting another auto immune disease. That’s because whatever propensity predisposes you to the development of the auto immune disease, makes you vulnerable to others because they work similarly as they have ‘auto immune’ in common.

With mental illness, people with bipolar often experience Borderline Personality Disorder at the same time, and ADHD. People with Depression often experience Anxiety at the same time.

Sounds bad?

The propensity is by no means a death sentence, it’s just like saying if you have red hair you are more likely to get skin cancer than if you have dark skin, but dark skinned people CAN get skin cancer and not every red head does. Propensity is not a certainty as there are other (epigenetic) factors at play as well as our friend CHANCE.

And chance, almost rhymes with choice – bringing us back to the point. Shame is a choice. It’s a choice we as people who experience mental illness can make, to avoid as much as possible, and it’s a choice people who know mentally ill people can make when they deal with them.

You can choose to treat others as you would wish to be treated. The law of karma let’s call it.

Or you can choose to satisify some blood lust within you and make someone else feel very, very bad. Yeah you have that power, you are almost a super hero – not.

Shame is inextricorbly linked with sexual abuse in childhood, rape, molestation, illness, rejection, certain religions, gender, sexuality and other societal conventions that often it appears, seek to remind us we are not good.

As women we are told, we are dirty if we sleep around.

As children we are told, we are perverted if we masturbate.

As loners we are told, we’re weird because we prefer a book to company.

The list goes on. It’s safe to say, it appears a fond past-time of humanity to judge and to shame. And we don’t have to be in 1600’s Salem!

Just because it’s 2017 don’t think this practice has stopped. We can find it in bullying, which incidentally, is the number one cause of teen suicide. We can find it in work-place bullying which owes a distinction because it affects older people and is growing in prevelency world-wide. We can find it in older populations who are ignored, neglected, considered less important and ‘past it’ to be contributors. We can find it in minority groups and ethnic groups, same-sex relationships, gender roles and identity or lack of, and all the shades inbetween.

My grandmother used to say; People don’t like what they can’t understand and they don’t like difference.

So I guess, if you’re left-handed, queer, red-haired, freckled, hazel-eyed and autistic you might feel left out.

Okay so that’s an extreme but how many of us don’t entirely fit in some way?

You only need to be into one thing others aren’t, or not like wearing dresses, or burn instead of tan, or have darker pigment than your other family members, to experience the feeling of shame imposed upon you by a bizzare set of ideals and rules.

In other words it’s modern society or as I like to call it, torture.

Except this didn’t start just recently, it started when we began to communicate with each other (read Vanity Fair the novel if in doubt) we use shame and shaming as a coping mechanism (attack other before we are attacked) a weapon (divide and conquer) and a tool (defeat the others first, win). Society is a battle-field. For the mentally ill they are easy targets, who among us who struggles to get out of bed in the morning can handle much more?

Even when someone doesn’t know it, they can shame others. It is very common place to say things without meaning them in a bad way. Perfectly ‘good’ and kind people can inadvertantly say something that can be taken the wrong way ‘I wish you felt better!’ and pain ensues.

Obviously you don’t want to walk around on tiptoe when talking to someone who is suffering, but at the same time, just as we should be aware of the sensitivity of other subjects we should consider the sensitivity of how we address depression and other mental diseases.

Not everyone who is bipolar is a mass murderer or school shooter

Not everyone who is schizophrenic will kill their parents

Not everyone who is depressed will jump off Golden Gate Bridge

But some may and those tiny minorities are but the extremes. Beneath those few extremes lie shades of grey. The depressed person who cuts themselves, the anorexic who develops heart problems, the BPD who alienates people and ends up alone, the bipolar or cannot read a book, and so it goes on.

Everyone has something. If we remember that, then we can treat mental disease the way it should be treated, as a disease, an illness, but not the sum of a person, only an element of their whole. Something to be conscious of, aware of, sensitive to, without stereotyping the whole.

The best technique in the world? Listen to what a person has to say. You can learn a lot. And by doing this, you afford an opportunity for your friend to speak about things without a feeling of shame or judgement. In the long run this acts much like talk therapy and can be incredibly cathartic as well as a really good way of realizing, mental illness doesn’t define you.

Mental Health Month “the invisible mentally ill”

Most people when faced with the knowledge someone is mentally ill says

why don’t you just get some help?

therein lies the rub

this writer can attest, ‘getting help’ isn’t as easy as clicking your red shoes together

In the US today there are large portions of what I term ‘shut-in depressives’ those people who are under-or-un diagnosed as suffering from Major Depressive Disorder. They are typically under-employed/unemployed/self-employed or on a pension. They do not factor into many of our statistics in this country. If we added them, imagine how much the landscape of mental health in this country would change? IE; More sick people than we realized.

Why aren’t they counted?

Many times if you aren’t insured by your full-time job you don’t have access to mental health resources. Even with insurance you are severely restricted to how much you can obtain. Individuals with this coverage often fear being discovered and do not use it, or fear the stigma from doctors who if they see ‘anxiety’ on your medical chart, will literally see any illness you have as being psychosomatic (in your head) so … chest pain? Anxiety. Headaches? Anxiety.

My friend who had headaches and was mentally ill was told, it’s anxiety.

It was a brain tumor.

Secondly; Those who are not full-time employees of a company who still insures their workers (and this is growing daily) has to purchase their own insurance. If you consider the cost of say, one of the lowest plans, at $450 a month, a car payment, plus a $8k deductible that has to be paid out of your pocket before you can begin being covered, how many people working say, part-time or a low to medium wage job can afford that? May as well not have insurance!

Of course if you want to pay out $900 a month like a friend of mine, you get great insurance. $900 will also pay for a rented apartment per month.

Thirdly; Those who choose not to go with the self-pay medical insurance are not irresponsible they are normal working folk who cannot afford to pay that much per month. They rely upon pay-as-you-go services like walk-in-clinics. Such clinics cannot refer you up the chain, so they’re great for a sprain or ant bites, not so good if there’s something seriously wrong.

Forth; The ER. The USA has seen huge numbers of people coming into local ER’s with mental health problems, they are second to major car accidents seen at ER’s and typically include the homeless, the low-income, the undocumented, and students. This is a short-term solution. If you are having a manic episode they will pump you full of pills, give you a script, a few lists of people you can follow-up with and send you on your way after a 3 day hold. Given that most state-run hospitals for mental illness were closed in favor of ‘care in the community’ more mentally ill people can be found in jail and prison than anywhere else. Second to that, the streets.

But what we do not consider, are the numbers of invisible mentally ill who fall through the cracks and defy the stereotypes. I will call those people high-functioning mentally ill, by this I do not mean they are ‘better’ than the mentally ill man on the street, but they are able to cover their mental illness a little more, and ‘act’ more functioning. This is the same as a high-functioning alcoholic, and it does in no way suggest those who are not, are weaker.

The high-functioning depressive is typically older. We hear a lot about teen depression because of the higher rates of suicide upon early diagnosis among teens. There are more resources for teens and young people than middle-aged brackets because the two age groups highest for suicide are the very young and the very old.

Where does that leave the 30-year-old mother suffering from postpartum depression or the 35-year-old man who is living in the back of his parents garden in a trailer or the 45-year-old wife who drinks during the day to cope?

The invisible and the high-functioning (because both are not mutually exclusive) walk among us. Typically if you ask them how they are doing they will say ‘fine’ and you will know they do not mean it but you will not ask them more and they will know they do not mean it and will not offer more. Why? Because unlike at 16 when you trust the world to want to listen, a few years down the road you get it, nobody wants to know.

And it’s not just that nobody wants to know about depression it’s that nobody wants to know a depressive, or be friends with a depressive, or be married to a depressive, or date a depressive, or hang out with a depressive.

Does that sound harsh? Do you feel the need to defend?

It’s a harsh truth because if you asked anyone, yourself included, would you rather be friends with someone who is depressive or not, most people statistically check the ‘not’ box. Does that mean if you are dating someone who reveals they are depressed you will automatically dump them? No because you are invested and loyal. But if you went on a dating site, would you choose the profile of someone who says they are depressed most of the time? A few will say yes, and mean it, but the majority, will not.

And that’s the crux of it. It’s a circular self-fulfilling prophecy.

The depressed person – puts off the non-depressed – by their sense of isolation and loneliness – and becomes more lonely and isolated because their depression causes others to avoid them.

So feeling isolated breeds more isolation in effect.

And they still say … snap out of it (like anyone who feels this way, is choosing that for a fun buzz)

Now, to be fair, isn’t it understandable and isn’t it unfair to expect people who are not depressed to ‘friend a depressive’ and be responsible for cheering them up? Sure. But that’s not what a depressed person needs. They know their partner, sister, mom, aunt cannot ‘cheer them up’ because it doesn’t work like that, and neither do magic wands.

What a depressed person wants is the same as what everyone else wants. They want to be accepted for who they are, they want to be respected, they want to be liked, they want to be loved.

But on the other hand they are battling feelings of isolation, alienation, despair, panic, anxiety, fear, nightmares, terror, self-hate, phobias, sensitivity and paranoia.

You may say, well if someone is paranoid then how am I supposed to help them?

Again, it’s not your job to ‘help’ it’s your role if you choose, to be in their life, just like you would anyone else.

For most this is a difficult chore. They find it hard when the depressed person bails on them because they cannot get out of bed, when they have a melt down for no apparent reason, when they are quiet and not talkative, when nothing they do seems to make them happy.

Oh happiness, the illusive demon for the depressed, always out of reach.

Or in the case of the bipolar, there, gone, there, gone, there, gone.

No depressed person or mentally ill person chooses their burden, and yet, the world is intolerant of their disease in a way that is unique to mental illness.

The next question has to be … why? We’ll deal with that in a future post.

So the bottom line is – among us today are many who are invisible to mental health services (of which there are precious few). They are not poor enough for the very lowest income options, they are not well off enough to realistically afford their own insurance, coverage or get a job that will provide that, and as America was founded on the work ethic and our health care was tied to our ability to work this was a problem that bore the need for alternatives, which we now have, but they are so expensive it defeats the point.

Where does the stay at home mom or stay at home wife, or part-time-worker with depression go to get help and treatment that is reliable, cost-effect, consistent and long enough in duration to have any effect?

Having lived in several countries I am in a position to attest, it’s not that much better in other countries. There are more services literally speaking in countries with socialized healthcare but they are so full as to be practically redundant for the complex needs of their societies. I have yet to find a model I would use to base future health care ideals upon.

Then of course you have countries like India, China, Russia, that have a mixed-bag in terms of their approaches to the issue of mental health. For some, it’s almost akin to a crime, for others, admitting it will effectively condemn you to forced inadequate treatments and large-scale stigmatization (more on stigma and shame in future posts) and others socially encourage the condemnation of the mentally ill so that it’s not even discussed and acknowledged.

So as a whole, when we look at all the countries that make up our planet, we are failing to help those who have mental illness, really, really failing. And worst still, there are those among us, who we don’t even know are suffering, who have nowhere to turn, and effectively subsist rather than exist.

You can see them if you look close enough. But most of us don’t want to, or are too ‘busy’ to care. With everything in our ever-busy lives, when do we have time? The only ones who may really try to do something, are going to be our nearest and dearest and for many depressed people there are no nearest and dearest.

What if you are alone more or less and you are mentally ill and you don’t have money, where do you go?

Posing this question to a mentally ill person in the midst of a crisis they are likely as not to say, I’d just give up and take my own life.

Next time you judge someone for being suicidal, consider, have we left many other options for them?

Mental Health Month

Fortunately quite a few people are making time for this important subject. Raising awareness.

Before you click off thinking; “I’ve heard this before / I know this already” consider the following;

  1. If you have not suffered from a mental health issue you’re in the minority

2. More people die from mental health influenced factors than anything else

3. There is today more depression in the western hemisphere than ever before and our answer is to medicate using medication that is poorly proven to resolve depression and was only ever meant as a temporary solution, with therapy a rare and restricted ‘luxury’

4. We are cutting back so many mental health resources we now have less than we did in 1970, yes that means we’re going backwards not forward

5. Whilst some mental health issues are better known and understood today than 40 years ago, the terrible truth is … they are judged just as much as they were before people knew more about them and those who suffer from mental illness are often pushed to breaking-point by others who see mental-illnesses as a “choice” even by carelessly chosen words.

Words like – Depression is looking back / anxiety is looking forward / wellness is in the present.

People may say things like ‘snap out of it’ and be well meaning even but imagine saying that to someone who has cancer?

The implied condemnation / judgement / criticism or just put-down in many ‘helpful’ comments furthers the progression of the disease.

Ultimately mental health is seen as a sign of character. If you are mentally ill you have a weak character. If you are not mentally ill you have a strong character. Follow the progression of that.

Strength does not come into whether someone is mentally ill or not, any more than if someone has breast cancer. But like blaming a smoker for their lung cancer, most people see mental illness as something that someone can change ‘if they just tried’ and more of a character flaw, a negativity, a bad attitude, than a crippling, life-reducing disease.

Still think we don’t need to talk about mental illness?